title: Body-mass index and progression of hepatitis B: a population-based cohort study in men.
abstract: OBJECTIVE
  To determine prospectively whether body-mass index (BMI) is associated with liver-related morbidity and mortality among male hepatitis B virus (HBV) carriers.
  
  
  METHODS
  We performed a prospective study of 2,903 male HBV surface antigen-positive government employees who were free of cancer at enrollment between 1989 and 1992. Main outcome measures included ultrasonography, biochemical tests, incident hepatocellular carcinoma (HCC), and liver-related death.
  
  
  RESULTS
  During mean follow-up of 14.7 years, 134 developed HCC and 92 died as a result of liver-related causes. In Cox proportional hazards models adjusting for age, number of visits, diabetes, and use of alcohol and tobacco, the hazard ratios for incident HCC were 1.48 (95% CI, 1.04 to 2.12) in overweight men (BMI between 25.0 and 29.9 kg/m(2)) and 1.96 (95% CI, 0.72 to 5.38) in obese men (BMI >or= 30.0 kg/m(2)), compared with normal-weight men (BMI between 18.5 and 24.9 kg/m(2)). Liver-related mortality had adjusted hazard ratios of 1.74 (95% CI, 1.15 to 2.65) in overweight men and 1.50 (95% CI, 0.36 to 6.19) in obese men. Excess BMI was also associated with the occurrence of fatty liver and cirrhosis detected by ultrasonography, as well as elevated ALT and gamma-glutamyltransferase (GGT) activity during follow-up. The association of BMI with GGT was stronger than with ALT, and elevated GGT activity and cirrhosis were the strongest predictors for incident HCC and liver-related death.
  
  
  CONCLUSIONS
  This longitudinal cohort study indicates that excess body weight is involved in the transition from healthy HBV carrier state to HCC and liver-related death among men.
authors.affiliation: Graduate Institute of Epidemiology, College of Public Health, National Taiwan University, Room 522, No.17, Xuzhou Rd, Zhongzheng District, Taipei City 10055, Taiwan. yumw@ntu.edu.tw
authors.forename: Ming-Whei
authors.initials: MW
authors.lastname: Yu
authors.forename: Wei-Liang
authors.initials: WL
authors.lastname: Shih
authors.forename: Chih-Lin
authors.initials: CL
authors.lastname: Lin
authors.forename: Chun-Jen
authors.initials: CJ
authors.lastname: Liu
authors.forename: Jhih-Wei
authors.initials: JW
authors.lastname: Jian
authors.forename: Keh-Sung
authors.initials: KS
authors.lastname: Tsai
authors.forename: Chien-Jen
authors.initials: CJ
authors.lastname: Chen
mesh_terms: D000328:Adult; D015992:Body Mass Index; D006528:Carcinoma, Hepatocellular / Q000150:complications* / Q000821:virology; D015331:Cohort Studies; D006509:Hepatitis B / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D006515:Hepatitis B virus / Q000378:metabolism; D006801:Humans; D008107:Liver Diseases / Q000150:complications / Q000628:therapy / Q000821:virology; D008113:Liver Neoplasms / Q000150:complications* / Q000821:virology; D008297:Male; D008875:Middle Aged; D050177:Overweight; D016016:Proportional Hazards Models; D011446:Prospective Studies; D016896:Treatment Outcome